NPIMap

Individual provider Active NPI

Kelly Risheill Gossrau

  • Speech-Language Pathologist
  • Creve Coeur, MO
National Provider Identifier
1093851974
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
107990 Issued in MO
Practice address
10560 Old Olive Street Rd
Suite 100
Creve Coeur, MO 63141-5916
Phone
(314) 567-4707
Fax
(314) 567-4505
NPI assigned
Jan 29, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 107990 MO Primary

Addresses

Primary practice location

10560 Old Olive Street Rd
Suite 100
Creve Coeur, MO 63141-5916

Mailing address

17057 Westridge Oaks Dr
Grover, MO 63040-1140
Phone (636) 405-0127

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
107990MOMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Sensory Solutions, LLC Speech-Language Pathologist Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1093851974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17057 WESTRIDGE OAKS DR",
            "city": "GROVER",
            "state": "MO",
            "postal_code": "630401140",
            "telephone_number": "636-405-0127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10560 OLD OLIVE STREET RD",
            "address_2": "SUITE 100",
            "city": "CREVE COEUR",
            "state": "MO",
            "postal_code": "631415916",
            "telephone_number": "314-567-4707",
            "fax_number": "314-567-4505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOSSRAU",
        "first_name": "KELLY",
        "middle_name": "RISHEILL",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-29",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MO",
            "license": "107990",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Creve Coeur, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.